Washington, D.C. — Physician assistants and nurse practitioners are more likely to treat patients who paid out of pocket than are physicians, results of a nationally representative analysis encompassing nearly 36 million outpatient visits suggest.

“There are appears to be some evidence that the probability of being treated by a particular type of provider group is conditional on patient method of payment,” Richard Dehn, MPA, PA-C, professor and department chair of Northern Arizona University’s Department of Physician Assistant Studies, and colleagues, reported during a poster session at IMPACT 2013.

To determine whether the source of payment for healthcare services influences the type of provider seen, Dehn and colleagues analyzed data on visits to non-federal outpatient departments between 2006 and 2010 from the National Hospital Ambulatory Medical Care Survey (NHAMCS).

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The analysis pooled cross-sectional data from 120,000 observations, representing nearly 36 million outpatient visits. Payment sources examined included private/managed care, Medicare, Medicaid, Worker’s Compensation, self-pay, and no pay (uncompensated or charity care).

Compared with physicians, physician assistants were 1.57 times more likely (95% CI: 1.39-1.77; P<0.01) to treat a patient paying out-of-pocket and nurse practitioners were 1.29 times more likely (95% CI: 1.19-1.41; P<0.01), the researchers found.

Furthermore, PAs were nearly twice as likely as physicians to treat patients whose primary source of payment was Worker’s Compensation (odds ratio 2.23; 95% CI: 1.78-2.79; P<0.01).

When stratified by major reason for visit, PAs were nearly three times more likely than physicians to receive out of pocket payments (OR 2.53; 95% CI: 1.93-3.31; P<0.01)  and nearly twice as likely to receive no compensation/charity care (OR 1.96; 95% CI: 1.28-2.99; P<0.01)  for preventive care.

“Lower labor costs of PAs and NPs may be one strategy to divert lower payments to lower paid employees,” the researchers wrote. “Because we see variation in the provider responsiveness based on the method of payment in multiple regression specifications, [this] suggests efforts to determine this relationship at the outpatient department level would be warranted in future research.”


  1. Dehn R et al. Poster Session. “Payment for Health Servic eDiffers depending on Type of Providers.” Presented at: Presented at: American Academy of Physician Assistants IMPACT 2013 Meeting. May 25-29, 2013. Washington, DC.